Have an HMO? 3 Reasons to See Your Primary Care Provider This Year

Amy Barczy

| 2 min read

Amy Barczy is a former brand journalist who authored content...

If you have health insurance, the beginning of the new year is a good time to check to see if you have an HMO plan or a PPO plan. That’s because HMO, or health maintenance organization, plans come with more specific rules. If you’re in an HMO plan, you pick one primary care provider and all of your health care services go through that doctor.
Here are three reasons to see your primary care provider this year if you have an HMO plan.

1. Lower health care costs.

With your primary care provider coordinating all your health care between their office and any specialists you may see, it means you’ll undergo less redundant or unneeded tests. Additionally, there will be less paperwork as you move from their office to see an in-network specialist. The result is lower health care costs – both for the provider, the insurance company and for you. 

2. It helps you see a specialist.

If you want to see a specialist doctor for a specific need – like consulting a dermatologist for a concerning rash – and you have an HMO plan, you first need to see your primary care provider. If they can’t help you with the rash, they would then refer you to an in-network dermatologist.
Women do not need a referral to see an obstetrician/gynecologist for routine preventive services or obstetrical care. And there are no referrals required for emergency care.

3. HMO plans require it.

In order for your HMO plan to cover any health services you receive, your care must be coordinated by your primary care provider. Some HMO plans require you to complete an assessment and to visit a doctor within a certain time frame early in the plan year. 

Benefits of HMO plans

HMO health plans often cost you less money each month in premium payments, and often offer you lower out-of-pocket costs for any doctor’s office visits, treatments, or tests.
HMO plans involve primary care providers more heavily in your health care to ensure you’re getting the right care, at the right place, at the right time.
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